Moral injury appraisals and dissociation: Associations in a sample of trauma-exposed community members

References

• American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders fourth edition text revision (DSM-IV-TR). https://doi.org/10.1176/appi.books.9780890423349
   Google Scholar
• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. https://doi.org/10.1176/appi.books.9780890425596
   Google Scholar
• Bailey, T. D., and Brand, B. L. (2017). Traumatic dissociation: Theory, research, and treatment. Clinical Psychology: Science & Practice, 24(2), 170–185. https://doi.org/10.1111/cpsp.12195
   Web of Science ®Google Scholar
• Barnes, H. A., Hurley, R. A., & Taber, K. H. (2019). Moral injury and PTSD: Often co-occurring yet mechanistically different. The Journal of Neuropsychiatry and Clinical Neurosciences, 31(2), A4–A103. https://doi.org/10.1176/appi.neuropsych.19020036
   PubMed Web of Science ®Google Scholar
• Borges, L. M., Desai, A., Barnes, S. M., & Johnson, J. P. M. (2022). The role of social determinants of health in moral injury: Implications and future directions. Current Treatment Options in Psychiatry, 9(3), 202–214. https://doi.org/10.1007/s40501-022-00272-4
   PubMedGoogle Scholar
• Boyer, S. M., Caplan, J. E., & Edwards, L. K. (2022). Trauma-related dissociation and the dissociative disorders: Neglected symptoms with severe public health consequences. Delaware Journal of Public Health, 8(2), 78–84. https://doi.org/10.32481/djph.2022.05.010
   PubMedGoogle Scholar
• Braitman, A. L., Battles, A. R., Kelley, M. L., Hamrick, H. C., Cramer, R. J., Ehlke, S., & Bravo, A. J. (2018). Psychometric properties of a modified moral injury questionnaire in a military population. Traumatology, 24(4), 301–312. https://doi.org/10.1037/trm0000158
   PubMedGoogle Scholar
• Briere, J., Dietrich, A., & Semple, R. J. (2016). Dissociative complexity: Antecedents and clinical correlates of a new construct. Psychological Trauma: Theory, Research, Practice, & Policy, 8(5), 577–584. https://doi.org/10.1037/tra0000126
   PubMed Web of Science ®Google Scholar
• Briere, J., Weathers, F. W., & Runtz, M. (2005). Is dissociation a multidimensional construct? Data from the multiscale dissociation inventory. Journal of Traumatic Stress, 18(3), 221–231. https://doi.org/10.1002/jts.20024
   PubMed Web of Science ®Google Scholar
• Brown, R. J. (2006). Different types of “dissociation” have different psychological mechanisms. Journal of Trauma and Dissociation, 7(4), 7–28. https://doi.org/10.1300/J229v07n04_02
   PubMedGoogle Scholar
• Chaplin, T. M. (2015). Gender and emotion expression: A developmental contextual perspective. Emotion Review: Journal of the International Society for Research on Emotion, 7(1), 14–21. https://doi.org/10.1177/1754073914544408
   PubMed Web of Science ®Google Scholar
• Coffey, S. F., Dansky, B. S., Falsetti, S. A., Saladin, M. E., & Brady, K. T. (1998). Screening for PTSD in a substance abuse sample: Psychometric properties of a modified version of the PTSD symptom scale self-report. Journal of Traumatic Stress, 11(2), 393–399. https://doi.org/10.1023/A:1024467507565
   PubMed Web of Science ®Google Scholar
• Currier, J. M., Foster, J. D., Karatzias, T., & Murphy, D. (2021). Moral injury and ICD-11 complex PTSD (CPTSD) symptoms among treatment-seeking veterans in the United Kingdom. Psychological Trauma: Theory, Research, Practice, & Policy, 13(4), 417–421. https://doi.org/10.1037/tra0000921
   PubMed Web of Science ®Google Scholar
• Currier, J. M., Holland, J. M., Rojas-Flores, L., Herrera, S., & Foy, D. (2015). Morally injurious experiences and meaning in salvadorian teachers exposed to violence. Psychological Trauma: Theory, Research, Practice, & Policy, 7(1), 24–33. https://doi.org/10.1037/a0034092
   PubMed Web of Science ®Google Scholar
• Darnell, B. C., Vannini, M. B. N., Grunthal, B., Benfer, N., & Litz, B. T. (2022). Adaptive disclosure: Theoretical foundations, evidence, and future directions. Current Treatment Options in Psychiatry, 9(3), 85–100. https://doi.org/10.1007/s40501-022-00264-4
   Google Scholar
• DePrince, A. P., Chu, A. T., & Pineda, A. S. (2011). Links between specific posttrauma appraisals and three forms of trauma-related distress. Psychological Trauma: Theory, Research, Practice, and Policy, 3(4), 430–441. https://doi.org/10.1037/a0021576
   Web of Science ®Google Scholar
• DePrince, A. P., Huntjens, R. J. C., & Dorahy, M. J. (2015). Alienation appraisals distinguish adults diagnosed with DID from PTSD. Psychological Trauma: Theory, Research, Practice, & Policy, 7(6), 578–582. https://doi.org/10.1037/tra0000069
   PubMedGoogle Scholar
• DePrince, A. P., Zurbriggen, E. L., Chu, A. T., & Smart, L. (2010). Development of the trauma appraisal questionnaire. Journal of Aggression, Maltreatment and Trauma, 19(3), 275–299. https://doi.org/10.1080/10926771003705072
   Google Scholar
• Domes, G., Schulze, L., Böttger, M., Grossmann, A., Hauenstein, K., Wirtz, P. H., Heinrichs, M., & Herpertz, S. C. (2010). The neural correlates of sex differences in emotional reactivity and emotion regulation. Human Brain Mapping, 31(5), 758–769. https://doi.org/10.1002/hbm.20903
   PubMed Web of Science ®Google Scholar
• Fani, N., King, T. Z., Powers, A., Hardy, R. A., Siegle, G. J., Blair, R. J., Surapaneni, S., van Rooij, S., Ressler, K. J., Jovanovic, T., & Bradley, B. (2021). Cognitive and neural facets of dissociation in a traumatized population. Emotion, 19(5), 863–875. https://doi.org/10.1037/emo0000466
   Web of Science ®Google Scholar
• Fischer, R., & Milfont, T. L. (2010). Standardization in psychological research. International Journal of Psychological Research, 3(1), 88–96. https://doi.org/10.21500/20112084.852
   Google Scholar
• Gillespie, C. F., Bradley, B., Mercer, K., Smith, A. K., Conneely, K., Gapen, M., Weiss, T., Schwartz, A. C., Cubells, J. F., & Ressler, K. J. (2009). Trauma exposure and stress-related disorders in inner city primary care patients. General Hospital Psychiatry, 31(6), 505–514. https://doi.org/10.1016/j.genhosppsych.2009.05.003
   PubMed Web of Science ®Google Scholar
• Gómez, J. M. (2019). What’s in a betrayal? Trauma, dissociation, and hallucinations among high-functioning ethnic minority emerging adults. Journal of Aggression, Maltreatment and Trauma, 28(10), 1181–1198. https://doi.org/10.1080/10926771.2018.1494653
   Web of Science ®Google Scholar
• Hoffman, J., Liddell, B., Bryant, R. A., & Nickerson, A. (2018). The relationship between moral injury appraisals, trauma exposure, and mental health in refugees. Depression and Anxiety, 35(11), 1030–1039. https://doi.org/10.1002/da.22787
   PubMed Web of Science ®Google Scholar
• Hsu, N., Badura, K. L., Newman, D. A., & Speach, M. E. P. (2021). Gender, “masculinity,” and “femininity”: A meta-analytic review of gender differences in agency and communion. Psychological Bulletin, 147(10), 987–1011. https://doi.org/10.1037/bul0000343
   Web of Science ®Google Scholar
• Jordan, A. H., Eisen, E., Bolton, E., Nash, W. P., & Litz, B. T. (2017). Distinguishing war-related PTSD resulting from perpetration- and betrayal-based morally injurious events. Psychological Trauma: Theory, Research, Practice, & Policy, 9(6), 627–634. https://doi.org/10.1037/tra0000249
   PubMed Web of Science ®Google Scholar
• Kinkel-Ram, S. S., Kunstman, J., Hunger, J. M., & Smith, A. (2021). Examining the relation between discrimination and suicide among Black Americans: The role of social pain minimization and decreased bodily trust. Stigma and Health. https://doi.org/10.1037/sah0000303
   Google Scholar
• Kucharska, J. (2017). Sex differences in the appraisal of traumatic events and psychopathology. Psychological Trauma: Theory, Research, Practice, & Policy, 9(5), 575–582. https://doi.org/10.1037/tra0000244
   PubMed Web of Science ®Google Scholar
• Lathan, E. C., Guelfo, A., La Barrie, D. L., Teer, A., Powers, A., Siegle, G., & Fani, N. (2023). Differing associations of depersonalization with skin conductance response during rest and breath-focused mindfulness in a trauma-exposed female population. Journal of Psychiatric Research, 162, 193–199. https://doi.org/10.1016/j.jpsychires.2023.05.028
   PubMed Web of Science ®Google Scholar
• Lathan, E. C., Powers, A., Kottakis, A., Guelfo, A., Siegle, G., Turner, J., Turner, M., Yakkanti, V., Jain, J., Mekawi, Y., Teer, A. P., Currier, J., & Fani, N. (2022). Civilian moral injury: Associations with trauma type and high-frequency heart rate variability in two trauma-exposed, community-based samples. Psychological Medicine, 1–10. https://doi.org/10.1017/S003329172200215X
   Web of Science ®Google Scholar
• Lebois, L., Harnett, N. G., van Rooij, S., Ely, T. D., Jovanovic, T., Bruce, S. E., House, S. L., Ravichandran, C., Dumornay, N. M., Finegold, K. E., Hill, S. B., Merker, J. B., Phillips, K. A., Beaudoin, F. L., An, X., Neylan, T. C., Clifford, G. D., Linnstaedt, S. D. … Ressler, K. J. (2022). Persistent dissociation and its neural correlates in predicting outcomes after trauma exposure. The American Journal of Psychiatry, 179(9), p661–672. https://doi.org/10.1176/appi.ajp.21090911
   PubMed Web of Science ®Google Scholar
• Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695–706. https://doi.org/10.1016/j.cpr.2009.07.003
   PubMed Web of Science ®Google Scholar
• Lloyd, C. S., Lanius, R. A., Brown, M. F., Neufeld, R. J., Frewen, P. A., & McKinnon, M. C. (2019). Assessing post-traumatic tonic immobility responses: The scale for tonic immobility occurring post-trauma. Chronic Stress, 3, 247054701882249. Article 2470547018822492. https://doi.org/10.1177/2470547018822492
   Google Scholar
• Lloyd, C. S., Nicholson, A. A., Densmore, M., Théberge, J., Neufeld, R., Jetly, R., McKinnon, M. C., & Lanius, R. A. (2021). Shame on the brain: Neural correlates of moral injury event recall in posttraumatic stress disorder. Depression and Anxiety, 38(6), 596–605. https://doi.org/10.1002/da.23128
   PubMed Web of Science ®Google Scholar
• Maguen, S., Griffin, B. J., Copeland, L. A., Perkins, D. F., Finley, E. P., & Vogt, D. (2020). Gender differences in prevalence and outcomes of exposure to potentially morally injurious events among post-9/11 veterans. Journal of Psychiatric Research, 130, 97–103. https://doi.org/10.1016/j.jpsychires.2020.06.020
   PubMed Web of Science ®Google Scholar
• Martin, C. G., Cromer, L. D., DePrince, A. P., & Freyd, J. J. (2013). The role of cumulative trauma, betrayal, and appraisals in understanding trauma symptomatology. Psychological Trauma: Theory, Research, Practice, & Policy, 5(2), 110–118. https://doi.org/10.1037/a0025686
   Web of Science ®Google Scholar
• McEwen, C., Alisic, E., & Jobson, L. (2021). Moral injury and mental health: A systematic review and meta-analysis. Traumatology, 27(3), 303–315. https://doi.org/10.1037/trm0000287
   Google Scholar
• Nash, W. P., Marino Carper, T. L., Mills, M. A., Au, T., Goldsmith, A., & Litz, B. T. (2013). Psychometric evaluation of the moral injury events scale. Military Medicine, 178(6), 646–652. https://doi.org/10.7205/MILMED-D-13-00017
   PubMed Web of Science ®Google Scholar
• Nickerson, A., Hoffman, J., Schick, M., Schnyder, U., Bryant, R. A., & Morina, N. (2018). A longitudinal investigation of moral injury appraisals amongst treatment-seeking refugees. Frontiers in Psychiatry, 9, 667. https://doi.org/10.3389/fpsyt.2018.00667
   PubMed Web of Science ®Google Scholar
• Norman, S. (2022). Trauma-informed guilt reduction therapy: Overview of the treatment and research. Current Treatment Options in Psychiatry, 9(3), 115–125. https://doi.org/10.1007/s40501-022-00261-7
   PubMedGoogle Scholar
• Platt, M. G., & Freyd, J. J. (2015). Betray my trust, shame on me: Shame, dissociation, fear, and betrayal trauma. Psychological Trauma: Theory, Research, Practice, & Policy, 7(4), 398–404. https://doi.org/10.1037/tra0000022
   PubMed Web of Science ®Google Scholar
• Platt, M. G., Luoma, J. B., & Freyd, J. J. (2017). Shame and dissociation in survivors of high and low betrayal trauma. Journal of Aggression, Maltreatment and Trauma, 26(1), 34–49. https://doi.org/10.1080/10926771.2016.1228020
   Web of Science ®Google Scholar
• Ponomareva, O. Y., & Ressler, K. J. (2021). Genomic factors underlying sex differences in trauma-related disorders. Neurobiology of Stress, 14, 100330. https://doi.org/10.1016/j.ynstr.2021.100330
   PubMed Web of Science ®Google Scholar
• Roth, S. L., Andrew, K., Protopopescu, A., Lloyd, C., O’Connor, C., Losier, B. J., Lanius, R. A., & McKinnon, M. C. (2022). Mental health symptoms in public safety personnel: Examining the effects of adverse childhood experiences and moral injury. Child Abuse and Neglect, 123, 105394. https://doi.org/10.1016/j.chiabu.2021.105394
   PubMed Web of Science ®Google Scholar
• Schiavone, F. L., Frewen, P., McKinnon, M., & Lanius, R. A. (2018). The dissociative subtype of PTSD: An update of the literature. PTSD Research Quarterly, 29(3), 1–13.
   Google Scholar
• Schimmenti, A. (2018). The trauma factor: Examining the relationships among different types of trauma, dissociation, and psychopathology. Journal of Trauma and Dissociation, 19(5), 552–571. https://doi.org/10.1080/15299732.2017.1.402400
   PubMed Web of Science ®Google Scholar
• Smith, K. L. W., Matheson, F. I., Moineddin, R., Dunn, J. R., Lu, H., Cairney, J., & Glazier, R. H. (2013). Gender differences in mental health service utilization among respondents reporting depression in a national health survey. Health, 5(10). https://doi.org/10.4236/health.2013.510212
   Google Scholar
• Sun, D., Phillips, R. D., Mulready, H. L., Zablonski, S. T., Turner, J. A., Turner, M. D., McClymond, K., Nieuwsma, J. A., & Morey, R. A. (2019). Resting-state brain fluctuation and functional connectivity dissociate moral injury from posttraumatic stress disorder. Depression and Anxiety, 36(5), 442–452. https://doi.org/10.1002/da.22883
   PubMed Web of Science ®Google Scholar
• Vaidya, V., Partha, G., & Karmakar, M. (2012). Gender differences in utilization of preventive care services in the United States. Journal of Women’s Health, 21(2), 140–145. https://doi.org/10.1089/jwh.2011.2876
   PubMed Web of Science ®Google Scholar
• van der Hart, O., Nijenhuis, E. R., & Steele, K. (2005). Dissociation: An insufficiently recognized major feature of complex posttraumatic stress disorder. Journal of Traumatic Stress, 18(5), 413–423. https://doi.org/10.1002/jts.20049
   PubMed Web of Science ®Google Scholar
• Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013). The PTSD checklist for DSM-5 (PCL-5). Scale available from the National Center for PTSD at. www.ptsd.va.gov
   Google Scholar
• Wolf, E. J., Lunney, C. A., Miller, M. W., Resick, P. A., Friedman, M. J., & Schnurr, P. P. (2012). The dissociative subtype of PTSD: A replication and extension. Depression and Anxiety, 29(8), 679–688. https://doi.org/10.1002/da.21946
   PubMed Web of Science ®Google Scholar
• Wolf, E. J., Miller, M. W., Reardon, A. F., Ryabchenko, K. A., Castillo, D., & Freund, R. (2012). A latent class analysis of dissociation and posttraumatic stress disorder: Evidence for a dissociative subtype. Archives of General Psychiatry, 69(7), 698–705. https://doi.org/10.1001/archgenpsychiatry.2011.1574
   PubMed Web of Science ®Google Scholar